Expanding Use of Plasma Injections in Orthopedic Care (Q&A)

In recent years, both famous athletes and not-so-famous weekend warriors have received platelet-rich plasma (PRP) injections to heal common orthopedic injuries, in many cases avoiding surgeries.

Although it is not exactly clear how PRP therapy works to heal muscle-tendon injuries and chronic conditions such as knee arthritis, this treatment has become a new frontier in orthopedic medicine that continues to evolve.

Laboratory studies have shown that PRP injections can speed up the healing process and regenerate tissue, but this treatment is still considered experimental. And since it’s an experimental procedure, it is not covered by all insurance policies.

Michael Swartzon, M.D., sports medicine physician with Miami Orthopedics & Sports Medicine Institute, is treating select patients with PRP injections and is optimistic about their broader use as longer-term studies provide more clarity.

“We are hoping that the PRP treatment provides a permanent cure (but) it is uncertain if that is the case,” says Dr. Swartzon. “We are seeing a majority of patients report significant improvement after PRP treatment, but we are not sure how long it will last.”

Dr. Swartzon answers several key questions from the Baptist Health News Team regarding PRP treatments:

Question: What is PRP therapy or injections?
Dr. Swartzon: PRP stands for Platelet-Rich Plasma. Our blood has different parts to it.  In simple terms, there are the red blood cells that carry oxygen, the white blood cells that fight infection and the plasma. The plasma has everything else, including the proteins, growth factors and repair cells.  It starts with a simple blood draw — like when you get lab work for your primary care physician — that is collected by a special kit. The kit is taken to a machine to separate the parts. With PRP, we concentrate the platelet part of the plasma using a centrifuge. The isolated PRP is used for the therapy.

Question: PRP is most commonly used to treat which kind of injuries?
Dr. Swartzon: PRP is essentially trying to repair any injury in the most natural way, using your own body’s system. PRP has been effectively used to treat acute muscle/tendon injuries, chronic muscle/tendon injuries and osteoarthritis of the joints.  We mostly use PRP for tendon injuries that have failed conservative treatment and arthritis in the joints.  For certain injuries, PRP is becoming the preferred therapy instead of cortisone.

Question: How is it used to treat orthopedic injuries? In other words, how does it work?
Dr. Swartzon: In orthopedics, the repair process is quite complicated and not fully understood. Orthopedic injuries usually do not heal well because of poor blood supply to the injured area.  PRP therapy can direct your repair cells to where they are most needed, like a damaged tendon. We are trying to jump-start or improve the body’s own repair process and regenerate the damaged area.

Question: What are some of the benefits of PRP?
Dr. Swartzon: PRP is a very safe and natural treatment. There are no known side-effects of PRP. Treating the body with medications, whether they are pills, topical gels or injections, has risks. Many people don’t like the idea of taking pills regularly or having cortisone injected into them and prefer PRP.  Avoiding surgery can also be a benefit.  In certain cases, PRP can help people heal faster, recover from an injury that has taken a long time to heal, or possibly help when we have no other treatment at all.

Question: What is known about the effectiveness, thus far, of PRP? What are the responses you’re getting from your patients?
Dr. Swartzon: Studies are very consistent in showing the excellent safety profile of PRP. The outcome research studies in the scientific literature are mixed. Some studies show PRP is more effective than other treatments like cortisone injections. Others show it is no different than our standard treatments.  In my patients, I have seen better responses from PRP than anything else for problems like tennis elbow, patellar tendonitis and plantar fasciitis. We’ve also had lots of success with PRP in patients with knee arthritis. Patients with arthritis have pain and limitations, even when they aren’t candidates for a joint replacement yet.  The newer studies coming out show even more encouraging results for PRP therapy.

Question: Are there long-term uncertainties regarding these injections and their success in avoiding surgeries? Or, could this be a good solution for patients who would like to avoid surgery?
Dr. Swartzon: We are hoping that the PRP therapy provides a permanent cure for their problem. Much of my answer would be based on the specific injury we are treating.  If it is tendon damage, the PRP promotes healing and hopefully repairs the tendon completely. A majority of patients report significant improvement after one treatment, return to their activity and avoid surgery. In cases of arthritis, we try to reverse the cartilage breakdown. It’s very difficult to fight this battle of aging and it is possible the treatment relieves symptoms by slowing down the arthritis. Most arthritic patients report significant relief but we are not sure how long it will last. Maybe they avoid replacement; maybe they delay it. The current studies do not follow patients long enough to know that information.  From a safety point of view, I have no concerns.

Question: Since these injections are still experimental, can you distinguish whether rest and rehab is just as effective, or does the combination of injections and rehab provide the best results?
Dr. Swartzon: The best scientific research narrows down any test to just one variable, in this case the PRP. However, this is difficult to do in real life where there are lots of variables. I advise all patients considering PRP to try rest and rehab first.  We strongly encourage patients who have PRP therapy to rest and then perform physical therapy. To me, rehab is an essential part of treatment for orthopedic injuries and a combination of the therapies will provide the best results.